An overview of the utility of prasugrel hydrochloride as a treatment option for ischemic stroke

ABSTRACT

Introduction

Prasugrel, a potent P2Y₁₂ receptor inhibitor, is not currently recommended in patients with stroke due to a higher rate of recurrent stroke. Prasugrel was associated with comparable efficacy to clopidogrel in reducing the risk of ischemic stroke in a recent phase III study.

Areas Covered

The authors provide an overview of the potential role of prasugrel in the management of ischemic stroke. The authors searched PUBMED, MEDLINE, and clinicaltrials.org and recently presented trials at the conferences for clinical trials of prasugrel therapy in patients with stroke and TIA, and important original investigations are reviewed.

Expert opinion

The recent PRASTRO-trials demonstrated comparable outcomes of lower maintenance dose (3.5 mg daily dose) with clopidogrel in East Asian stroke patients, thus can be a credible option as a P2Y₁₂ receptor inhibitor. It can also be considered as a credible option in other races and ethnicities and in other clinical situations that may require DAPT, such as intracranial or carotid stenting. Since prasugrel is associated with a superior antiplatelet effect and is not influenced by genetic polymorphisms, there is no need for platelet function or genetic testing. More work is needed to establish the safety and efficacy of low-dose prasugrel plus aspirin in comparison with currently used clopidogrel plus aspirin in non-East Asian populations.

KEYWORDS:

• Prasugrel
• clopidogrel
• stroke
• transient ischemic attack
• East Asians
• Antiplatelet therapy

Article highlights

• Lower maintenance dose (3.5 mg daily dose) prasugrel is associated with comparable efficacy and safety outcomes with clopidogrel in East Asian stroke patients.

• Lower maintenance dose prasugrel can be a credible option as a P2Y₁₂ receptor inhibitor in patients with stroke and TIA.

• It can also be considered as a credible option in other races and ethnicities and in other clinical situations that may require DAPT such as intracranial or carotid stenting.

• Prasugrel is associated with a superior antiplatelet effect and is not influenced by genetic polymorphisms, and there is no need for platelet function or genetic testing.

• The safety and efficacy of low-dose prasugrel need to be established in non-East Asian populations.

Declaration of interest

P Gurbel has received consulting fees and/or honoraria from Bayer, Otitopic/Vectura, Janssen Pharmaceuticals, the Cleveland Clinic, Wolters Kluwer Pharma, Web MD, Medscape and Baron and Budd. P Gurbel has also received institutional research grants from Haemonetics, Janssen Pharmaceuticals, Bayer Healthcare, Instrumentation Laboratories, Idorsia, Otitopic, Hikari Dx, and Novartis. P Gurbel has two patents entitled ‘Detection of restenosis risk in patients issued’ and ‘Assessment of cardiac health and thrombotic risk in a patient.’ P Gurbel was also an expert witness in a lawsuit associated with Plavix. U Tantry has received honoraria from Wolters Kluwer Pharma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.